Use of NSAIDS, ACE inhibitors, ARBs or RAAS in Suspected or Confirmed COVID-19 Patients
RE: Use of nonsteroidal anti-inflammatory drugs (NSAIDs) and angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) or other renin angiotensin aldosterone system (RAAS) antagonists in suspected or confirmed COVID-19 patients.
The Summary for Patients
There is information circulating in the media that certain drugs and medications may cause side effects for individuals suspected to have or diagnosed with COVID-19. UW Health recommends:
- Patients who rely on NSAIDs, such as ibuprofen, to treat chronic diseases should not stop taking them without talking to their provider
- Patients with conditions such as heart failure, hypertension, or ischemic heart disease should continue to take RAAS antagonists unless otherwise directed by their physician
Background and Recommendations
Background: A recent warning by the French health ministry advised individuals with COVID-19 against use of NSAIDS because some COVID-19 patients experienced serious side effects. The warning advised use of acetaminophen instead.
Recommendation: Consistent with a recent FDA statement noting no evidence linking NSAID usage to worsening COVID-19 symptoms, UW Health deems it reasonable for confirmed or suspected COVID-19 patients to use either acetaminophen or ibuprofen for pain or fever, per the labeled instructions. Patients who rely on NSAIDs to treat chronic diseases should not stop taking them without talking to their provider.
Background: A March 11, 2020 letter published in The Lancet hypothesized that ACE inhibitors and ARBs could increase the risk for developing severe COVID-19.
Recommendation: Given no known clinical data supporting a link between use of RAAS blockers and severe COVID-19 infection, UW Health endorses the position of the Heart Failure Society of America, American Heart Association, and American College of Cardiology. This statement from three leading U.S. cardiology groups recommends continuation of RAAS antagonists for patients with conditions such as heart failure, hypertension, or ischemic heart disease.
If patients with cardiovascular disease are diagnosed with COVID-19, individualized treatment decisions should be made according to each patient’s hemodynamic status and clinical presentation. Decisions to add or remove any RAAS-related treatments should be guided by standard clinical practice.
Date Published: 03/22/2020